Effectiveness and cost-efficacy of diuretics home administration via peripherally inserted central venous catheter in patients with end-stage heart failure.

BACKGROUND: End-stage heart failure (ESHF) is characterized by severe cardiac dysfunction with persistent disabling symptoms and recurrent acute decompensated heart failure (ADHF), despite guideline-directed medical therapy. The aim of this study was to evaluate the efficacy and safety of intravenous diuretics administration at home through a peripherally inserted central venous catheter (PICC) in ESHF patients. METHODS AND RESULTS: Forty-one ESHF patients received PICC implantation for intravenous diuretic administration at home. The primary efficacy endpoint was the patient-level number of HF hospitalizations in the short (1-3 months), medium (six months), and long term (1 year), before and after PICC implantation. Pre- and post-PICC ADHF-free days were also evaluated as co-primary endpoint. Secondary endpoints comprised changes in clinical, laboratory and echocardiographic parameters, and device safety. A cost-effectiveness analysis was performed to estimate the economic impact of using PICC. For each time frame analyzed, a significant reduction in the number of hospitalizations due to ADHF was observed, resulting in a significant increase in ADHF-free days (71 ± 44 vs. 163 ± 136, p = 0.003). In matched patients' analysis, significant decrease in body weight (68 ± 16 kg vs. 63 ± 10 kg, p = 0.041) and mitral regurgitation grade 3/4 (55% vs. 18%, p < 0.001) were also observed. Freedom from PICC-related complications was observed in 61% of patients. A significant reduction in overall ADHF-hospitalizations cost was observed. CONCLUSIONS: This proof-of-concept study demonstrates the effectiveness and safety of home administration of intravenous diuretic therapy via PICC in ESHF patients. This palliative cost-effective strategy can be taken in consideration for selected end-stage patients no longer responsive to conventional therapies.

Contributing factors for a late spontaneous peripherally inserted central catheter migration: a case report and review of literature.

PURPOSE: Peripherally inserted central catheters (PICCs) are associated with some adverse events, the most frequent are thrombosis, tip catheter malposition and spontaneous late migration. However, the cause of spontaneous late migration in most cases remains unknown. We carried out this study to add data to the literature on PICCs late spontaneous migration. METHODS: We conducted a systematic review of all manuscripts describing PICC spontaneous late migration in adult populations and we also described two cases of late PICCs migration. RESULTS: We identified five studies for a total of 58 cases of PICC late migration. In our two cases, patients' activity is an important contributing factor for late spontaneous PICC migration. CONCLUSIONS: To avoid late catheter misplacement, initial malposition should be immediately identified and promptly corrected and a detailed patients training should be carried out.